Arguments Against Obesity As A Disease #9: Its Just A Risk Factor
Next, in my miniseries on arguments I commonly hear against the notion of calling obesity a disease, is that it is “just a risk factor” for other diseases. This may be true, if you just (wrongly) considered elevated BMI as your definition of obesity, because no doubt, people with higher BMI levels carry a higher risk for obesity related complications including type 2 diabetes, sleep apnea, fatty liver disease, hypertension – just to name a few. (Note that increased risk is not the same as actually having the condition!). However, when you use the actual WHO definition of obesity, namely, “accumulation of excess or abnormal fat that impairs health”, obesity is no longer just a risk factor – it is now (by definition) impairing your health, which makes it far more than just a risk factor. So while someone with a BMI of 35 may be at risk of developing obesity (not the same as having it), when their excess fat actually starts impairing their health, it de facto becomes a disease in its own right. Even then, one might argue that obesity itself is not the disease, rather the complications of obesity are the real disease. This notion is both right and wrong. There are many conditions that are both diseases in their own right as well as risk factors for other diseases or complications. Take type 2 diabetes for instance – it is both a disease in itself but also a risk factor for coronary heart disease or end-stage kidney disease. Take hypertension – a disease in its own right but also a risk factor for strokes and heart attacks. Take gastro-oesophageal reflux disease, which is also a risk factor for Barrett’s disease and oesophageal cancer. Take fatty liver disease, which is also a risk factor for cirrhosis. Gall bladder stones, which is also a risk factor for pancreatitis. Multiple sclerosis, which is also a risk factor for neurogenic bladder and pyelonephritis. The list goes on and on. So just because obesity is also a risk factor for a wide range of other medical problems, it does not make obesity any less of a disease in its own right. When excess or abnormal body fat affects health – it’s a disease. When it doesn’t, it’s at best a risk factor. That, is perhaps a subtle but important distinction. @DrSharma Toronto, ON
Arguments Against Obesity As A Disease #8: Promotes Helplessness And Hopelessness
Continuing in my miniseries on arguments I hear against calling obesity a disease, I now discuss the objection, that doing so promotes a sense of helplessness or even hopelessness in people who carry extra weight. First of all, as noted previously, carrying extra weight is NOT the definition of obesity. For someone to have obesity they need to be carrying weight that is actually due to excess or abnormal fat tissue AND there has to be some negative impact of that fat tissue on their health – otherwise they do not have obesity!. That said, I am not sure how calling obesity on changes anything in terms of helplessness or hopelessness. Yes, the effective options to better manage obesity are limited and most people will likely struggle simply not to gain even more weight – but that fact doesn’t change whether you call obesity a disease or not. Indeed, there are many diseases for which we lack effective treatments (e.g. Alzheimer’s disease, multiple sclerosis), this does not make any of them any less of a disease. As for hopelessness, just because you are diagnosed with a chronic disease doesn’t mean everything is hopeless. In fact, there are many people living with chronic diseases that are controlled and well managed (e.g. diabetes, hypertension, sleep apnea), who do just fine (with treatment) and go on to live long and productive lives. Obviously, we need better treatments for obesity but even without those, people living with obesity can change the course of their disease by identifying and addressing the root causes of their weight gain (e.g. depression, PTSD, emotional eating, etc.) and adopting behaviours, which even if not resulting in any noticeable weight loss, can markedly improve their health and well-being. Again, whether you call obesity a disease or not is completely irrelevant to whether or not you feel helpless or hopeless – the management approach would be the same, except that hopefully it will shift attention to a chronic disease strategy that requires long-term sustainable management rather than an acute intervention that is unsustainable. If we are serious about providing patients with help and hope, let us get serious about finding and providing better treatments for this disease. @DrSharma Toronto. ON
Arguments Against Obesity As A Disease #5: Reduces Personal Responsibility
In my miniseries on arguments that I often hear against calling obesity a chronic disease, I now turn to the objection that declaring obesity a disease would reduce or even abolish personal responsibility. The argument being, that the term “disease” carries the connotation of being inevitable and will thus reduce motivation in patients to do anything about it. This is complete nonsense! When has calling something a disease ever taken away an individuals “responsibility” to do what they can to avoid or ameliorate it? Take for example type 2 diabetes – a very avoidable and modifiable condition. Calling diabetes a disease does not mean that the individual can do nothing to prevent it or that, once it occurs, the patient can do nothing to change the course of the disease – of course they can and should and often do! Or take people with a high risk of heart disease or lung disease or bone and joint disease or even cancer – in no instance do we expect less of patients to do their part in helping manage these conditions just because we call them “diseases”. There is even a term for this – it is called “self-management” – a key principle of chronic disease management. The course of almost every chronic disease can be changed by whether or not patients change their diet, follow their exercise program, monitor their symptoms, take their medications, come in for their visits – all a matter of “responsibility” if you so wish. So just how exactly would calling obesity a disease take away from any of this? Frankly, I cannot help but sense that people who use this argument most often, are erring on the side of “shame and blame” and probably still see obesity largely as a matter of personal “choice” rather than the complex multifactorial problem that it actually is. Indeed, the opponents often appear “morally” opposed to the very notion of accepting obesity as a disease, as it now gives people the “excuse” to not do anything about it. Sorry, but this whole line of arguing reeks of nothing less than weight bias and discrimination. As far as I can tell, calling something a disease often leads to exactly the opposite response – when obesity happens (and it can happen to anyone), it places a tremendous mental, physical and social burden on the people who get it – no matter what you call it. People living with obesity… Read More »
Arguments Against Obesity As A Disease #4: Distracts From Obesity Prevention
Continuing in my mini series on the pros and cons of considering obesity a chronic disease, I would like to now discuss the perhaps most illogical argument against recognising obesity as a disease that I often hear, “Calling obesity a disease will reduce our efforts at prevention”. This argument makes virtually no sense at all, as I cannot think of a single “preventable” disease, where calling it a “disease” would have reduced or thwarted prevention efforts. Whether the aim is to prevent heart disease (dietary recommendations, fitness, smoking cessation), cancers (physical activity, healthy diets, smoking cessation, sunlight exposure), infectious diseases (vaccinations, food safety, hand washing, condom use), road accidents (helmets, seat belts, speed limits), in no instance has calling something a “disease” ever stopped us from doing the utmost for prevention (although more can always be done). Rather, if you truly embrace the concept that obesity, once established, becomes a life-long problem for which we have no cure (the very definition of “chronic disease”), we should be doubling or even quadrupling our efforts at prevention. After all, who would want to be stuck with a chronic disease, if it can indeed be prevented? Governments, NGOs and individuals should be even more enthusiastic about preventing a “real” disease than simply modifying a “risk factor” (which sounds a lot less threatening). Indeed, if I was working in population health, I’d be all for emphasizing just how terrible and devastating the disease of obesity actually is – all the more reason to double down on efforts to do what it takes to prevent it. In fact, considering obesity a “real disease” would put all the folks working hard to prevent obesity right up there on par with those working to prevent “real” diseases like cancer, HIV/AIDS, or Alzheimer’s disease. Thus, the argument that calling obesity a “disease” would somehow distract from efforts to prevent it makes absolutely no sense at all. @DrSharma New Orleans, LA
Arguments Against Obesity As A Disease #3: Obesity Is Modifiable And Preventable
Continuing in my mini series on arguments that I often hear against considering obesity a chronic disease, I turn to another common argument, “Obesity cannot be a disease because it is preventable and modifiable.” That may well be the case (although, we must admit that we are doing a remarkably poor job of either preventing or modifying it), but so what? There are 100s of diseases that are both preventable and modifiable – and yet no one would argue that they should not be considered diseases. In fact, virtually all “lifestyle” diseases (by definition) are preventable and modifiable. Take for instance strokes and heart disease – most strokes and the vast majority of heart attacks are both preventable and modifiable (once they occur). So are diabetes, osteoarthritis, obstructive lung disease and many forms of cancer, not to mention the many infectious diseases that are both preventable and modifiable. There are even a number of in-born genetic diseases that may be preventable or modifiable (e.g. phenylketonuria). Thus, the fact that a disease can be prevented or modified (once it occurs) says nothing about whether something qualifies as a disease or not. That said, as recently pointed out by Ted Kyle, for all practical purposes, obesity is proving pretty hard to modify and even harder to prevent in real life. It may therefore be more accurate (and honest) to say that obesity is “theoretically” preventable and modifiable – while we await large-scale real-life examples demonstrating that this is in fact the case, and not just limited to relatively rare exceptions like the 1990’s catastrophic economic crisis in Cuba. Let’s remind ourselves that there is a vast difference between “efficacy” and “effectiveness” of proposed measures to “prevent” and “modify” obesity. But even if we did have ample proof that obesity can indeed be prevented or modified by most people, it still says nothing that would speak against recognising excess or abnormal body fat that affects your health as a disease. @DrSharma Berlin, Germany
Watch Dr. Sharma in the News!
Listen to Dr. Sharma!
